Claims Processor (Dearborn, MI)

Exemption Status:  Non-Exempt 
Reports to:    Manager, Claims Processors
Job Code:  Salary Grade:    Union – Grade 4

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

*Shift hours: 8am EST - 4:30pm EST Monday - Friday.

The Claims Processor is responsible for reviewing, verifying, and processing insurance or healthcare claims to ensure they are accurate and meet company or policy guidelines.

How you will make an impact: ​​

• Verify the accuracy of claims data entered by a data entry clerk and accurately complete the data entry of additional claims data necessary to adjudicate the claim. 
• Research claims for additional or missing information. 
• Utilize pre-established screening guidelines and templates to review claims information to determine member eligibility, level of benefits and if claims should be paid. 
• Route claims information to appropriate departments for action, if necessary. 
• Review open claims’ reports on a daily basis  to ensure that claims are processed quickly and accurately while meeting Departmental accuracy, productivity and performance standards
• Process mailbacks and submit for audit.
• Complete daily production logs and turn them in daily to the Claims Department Manager by the end of shift or before leaving for the day.
• Ensure that any data required for reporting purposes is entered as instructed by auditor or directed by management.
• Promptly raise any issues delaying resolution of the claim to management.
• Contribute to overall success of the claims department in meeting performance guarantees to customers and maintaining customer standards. 

Minimum Requirements

• High school diploma or a GED equivalent.
• 1 year of claims processing or medical billing experience required

Preferred Skills, Capabilities and Experiences

• Claims processing experience preferred.
• Claims/Billing certification from an accredited business institution preferred
• Knowledge and experience using management information systems and software CAS or other computerized claims processing system preferred.
• Word processing and excel experience preferred.